Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Department of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Catheter Cardiovasc Interv. 2021 Feb 1;97(2):E263-E273. doi: 10.1002/ccd.29067. Epub 2020 Jun 28.
To evaluate the additive prognostic value of myocardial, inflammatory, and renal biomarkers according to frailty status in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS).
A total of 111 subjects who underwent TAVR at Hospital Italiano de Buenos Aires, Argentina between January 2016 and December 2018 were retrospectively reviewed. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hs-cTnT), C-reactive protein (CRP), cystatin-c (Cys-C) and carbohydrate antigen-125 (CA-125) were assessed prior to TAVR. Frailty status was assessed according to the fried physical frailty phenotype (FPFP). The primary endpoint was defined as all-cause death and/or readmission for worsening congestive heart failure (CHF) within the first year after TAVR.
Of the 111 patients included, 48/111 (43%) were considered to be "frail" according to the FPFP. Among biomarkers, we found CA-125 to be strongly associated with the primary endpoint (p = .006). CA-125 ≥ 18.2 U/ml was present in 41% and was associated with a higher rate of the primary endpoint (31% vs. 9%; p = .003). After multivariable adjustment, CA-125 ≥ 18.2 U/ml (hazard ratio [HR] 3.17; p = .024) was the only independent predictor of the primary endpoint. Finally, the inclusion of CA-125 to frailty significantly improved C-index (0.68-0.74; p < .05), and provided a Net Reclassification Improvement (NRI) of 0.34 (95% CI 0.19-0.49, p = .031), largely through reductions in risk estimates among pre-frail and frail patients.
CA-125, a tumor biomarker, outperformed frailty for predicting the primary endpoint within the first year after TAVR.
评估心肌、炎症和肾脏生物标志物根据虚弱状态在经导管主动脉瓣置换术（TAVR）患者的预后的附加价值主动脉瓣狭窄（AS）。
共回顾性分析了 2016 年 1 月至 2018 年 12 月在阿根廷布宜诺斯艾利斯意大利医院接受 TAVR 的 111 例患者。术前评估了 N 端脑利钠肽前体（NT-proBNP）、高敏肌钙蛋白 T（hs-cTnT）、C 反应蛋白（CRP）、胱抑素 C（Cys-C）和碳水化合物抗原 125（CA-125）的血浆水平。根据 fried 身体虚弱表型（FPFP）评估虚弱状态。主要终点定义为 TAVR 后 1 年内全因死亡和/或因充血性心力衰竭（CHF）恶化再次入院。
111 例患者中，48/111（43%）根据 FPFP 被认为是“虚弱”。在生物标志物中，我们发现 CA-125 与主要终点有很强的相关性（p =.006）。CA-125≥18.2 U/ml 占 41%，与主要终点发生率较高相关（31%比 9%；p =.003）。多变量调整后，CA-125≥18.2 U/ml（风险比[HR]3.17；p =.024）是主要终点的唯一独立预测因子。最后，将 CA-125 纳入虚弱状态显著提高了 C 指数（0.68-0.74；p <.05），并提供了 0.34 的净重新分类改善（NRI）（95%可信区间 0.19-0.49，p =.031），主要通过降低虚弱和脆弱患者的风险估计。
肿瘤标志物 CA-125 优于虚弱状态预测 TAVR 后 1 年内的主要终点。
